Journal Information
Vol. 92. Issue 4.
Pages 231-234 (01 April 2020)
Vol. 92. Issue 4.
Pages 231-234 (01 April 2020)
Scientific Letter
DOI: 10.1016/j.anpede.2019.04.017
Open Access
Distribution of tuberculosis incidence rates in children under 15 years old according to poverty areas in Seville
Distribución de las tasas de incidencia de tuberculosis en menores de 15 años según zonas de pobreza de la ciudad de Sevilla
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Sebastián Tornero Patricioa,
Corresponding author
sebastornero@yahoo.es

Corresponding author.
, Antonio Daponte Codinab, Liliana Charris-Castroc
a Pediatría de Atención Primaria, Distrito Sevilla de Atención Primaria, Servicio Andaluz de Salud, Centro de Salud Polígono Norte, Sevilla, Spain
b Ciber de Epidemiología y Salud Pública (CIBERESP) y Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Granada, Spain
c Unidad de Cuidados Intensivos, Hospital UniversitarioVirgen del Rocío, Servicio Andaluz de Salud, Sevilla, Spain
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Table 1. Incidence of tuberculosis in children aged less than 15 years by subdistrict of the city of Seville in years 2013, 2014 and 2015.
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Dear Editor:

In May 2014, the World Health Assembly approved the action framework of the World Health Organization (WHO) Towards tuberculosis elimiation1 with the objective of eliminating tuberculosis (TB) as a global health problem by 2035. This would require a 95% reduction in TB mortality and a 90% reduction in its incidence relative to 2015. The action framework includes policy and budget measures at the national and international levels ranging from guaranteeing universal access to health care to addressing the social and economic factors that have an impact on this disease.2 Tuberculosis is associated with poverty, social exclusion and inequality, and there is evidence that factors such as low educational attainment, unemployment and low socioeconomic status (SES) are associated with an increased incidence and prevalence of TB.3

Low-resource countries have the highest incidence of TB and the highest associated mortality. Nevertheless, the action framework of the WHO also includes strategies for low-incidence countries (fewer than 10 cases/100 000 inhabitants/year) such as Spain.2 According to the latest report of the Red Nacional de Vigilancia Epidemiológica (Spanish National Network of Epidemiological Surveillance), the overall incidence of TB in Spain in 2016 was 10.38 cases per 100 000 inhabitants (4.10 in children aged less than 15 years).4 The incidence in the population aged less than 15 years in Spain in years 2013, 2014 and 2015 was of 5.33, 4.35 and 5.05 cases per 100 000 inhabitants, respectively. Although there is a decreasing trend in the incidence of TB nationwide, the incidence is decreasing by less than 11% per year (the target established by the WHO).

In order to analyse the distribution of cases of TB in children aged less than 15 years living in Seville based on the SES of the neighbourhoods where they resided, we calculated the annual incidence of cases of TB in children notified to the Department of Epidemiology of the Health District of Seville of the Department of Health of Andalusia in years 2013, 2014 and 2015. We obtained data on the geographical distribution by administrative subdistricts of the city of Seville and the total population aged less than 15 years residing in each subdistrict through the Urban Audit Project of the Instituto Nacional de Estadística (National Institute of Statistics).5 Since data for the population distribution by subdistrict was not available for 2014, we calculated the incidence for 2014 using the population distribution of 2013. We defined low-SES subdistricts as those containing 1 or more of the areas established as areas in need of social transformation (ANSTs) in the city of Seville based on the classification of residential areas with structural poverty established by the Government of Andalusia (based on data on variables such as income, education, unemployment, social exclusion etc).6 We calculated the incidence ratio (IR) of the incidence in subdistricts containing ANSTs relative to those that did not contain ANSTs for each of the 3 years under study.

The annual incidence of TB in the population aged less than 15 years in the city of Seville in the 3 years under study were higher than the nationwide average in Spain of this age group: 6.61 cases per 100 000 inhabitants aged less than 15 years in 2013, 14.71 in 2014 and 8.54 in 2015 (Table 1). The maximum differences in the calculated incidence between districts in 2014 (using the distribution of the population by subdistrict of 2013) and in 2015 was of +/- 3 cases per 100 000 inhabitants, and we found no changes in incidence in the subdistricts with ANSTs or the subdistricts without ANSTs in 2014.

Table 1.

Incidence of tuberculosis in children aged less than 15 years by subdistrict of the city of Seville in years 2013, 2014 and 2015.

Subdistricts  Year 2013Year 2014Year 2015
  Population <15 yTuberculosisPopulation <15 yTuberculosisPopulation <15 yTuberculosis
  n  n  Incidencea  n  n  Incidencea  n  n  Incidencea 
1-A  2653  12.24  37.69  2653  12.24  0.00  2569  12.22  38.92 
1-B  2897  13.01  0.00  2897  13.01  0.00  2966  13.67  0.00 
1-C  1983  12.65  0.00  1983  12.65  0.00  1988  13.05  0.00 
2-A  1425  11.07  0.00  1425  11.07  0.00  1494  11.82  66.95 
2-B*  4163  13.46  0.00  4163  13.46  0.00  4070  13.54  49.14 
2-C  1894  11.89  0.00  1894  11.89  0.00  1868  12.04  0.00 
2-D  2041  12.15  0.00  2041  12.15  0.00  2043  12.46  0.00 
3-A  4175  14.16  0.00  4175  14.16  0.00  4167  14.18  24.00 
3-B  2778  12.91  0.00  2778  12.91  0.00  2839  13.34  0.00 
4-A  3934  22.55  0.00  3934  22.55  0.00  4044  22.97  0.00 
4-B*  3591  14.09  55.69  3591  14.09  0.00  3579  14.28  27.94 
4-C  1650  12.95  0.00  1650  12.95  0.00  1672  13.21  0.00 
4-D  2029  13.17  0.00  2029  13.17  0.00  1890  12.71  0.00 
4-E*  2703  14.81  37.00  2703  14.81  221.98  2714  15.00  73.69 
5-A*  3929  22.58  50.90  3929  22.58  25.45  3703  21.59  27.01 
5-B  1481  11.37  0.00  1481  11.37  0.00  1459  11.72  0.00 
5-C*  1397  15.30  0.00  1397  15.30  0.00  1319  14.85  0.00 
5-D  1896  15.52  0.00  1896  15.52  0.00  1860  15.40  0.00 
5-E  3119  15.02  0.00  3119  15.02  0.00  3089  14.90  0.00 
6-A  2250  13,32  0,00  2250  13,32  88,89  2194  13,18  0,00 
6-B  1296  11,56  0,00  1296  11,56  77,17  1358  12,28  0,00 
6-C  2659  12,43  0,00  2659  12,43  0,00  2650  12,63  0,00 
7-A  5217  16,61  0,00  5217  16,61  0,00  5184  16,23  0,00 
7-B*  2452  15,62  0,00  2452  15,62  0,00  2348  15,35  0,00 
7-C*  2058  15,88  0,00  2058  15,88  0,00  2099  16,22  0,00 
7-D  1842  13,22  0,00  1842  13,22  54,30  1743  12,70  0,00 
8-A  2299  11,92  43,49  2299  11,92  0,00  2230  11,86  0,00 
8-B  1226  15,26  0,00  1226  15,26  0,00  1217  15,60  0,00 
8-C  1768  12,99  0,00  1768  12,99  56,55  1740  12,92  0,00 
8-D  2626  12,44  0,00  2626  12,44  0,00  2661  12,79  0,00 
9-A*  3291  18,35  0,00  3291  18,35  0,00  3190  17,80  0,00 
9-B  3153  16,06  0,00  3153  16,06  0,00  3235  16,68  0,00 
9-C  3749  15,81  0,00  3749  15,81  0,00  3439  14,67  0,00 
9-D  9527  24,30  0,00  9527  24,30  31,49  9471  22,90  0,00 
10-A  1503  14,10  0,00  1503  14,10  0,00  1563  14,78  0,00 
10-B  5927  20,05  0,00  5927  20,05  0,00  6194  20,60  0,00 
11  3397  13,63  0,00  3397  13,63  0,00  3538  14,24  0,00 
TOTAL  105976  14,71  6,61  105976  14,71  15  14,15  105400  15,19  8,54 
[0,1-13]ANST
YES  23585  22,26  21,20  23585  22,26  30,40  23023  21,84  21,72 
NO  82391  77,74  2,43  82391  77,74  9,71  82377  78,16  4,86 

ANST, subdistrict with areas in need of social transformation; <15 y: age less than 15 years.

a

Incidence: cases per 100 000 inhabitants.

*

Subdistricts containing areas in need of social transformation.

The IR comparing subdistricts of Seville with areas with structural poverty and the subdistricts without such areas revealed significant differences, with the incidence being up to nearly 9 times greater in the most disadvantaged areas (IR 2013 = 8.73; IR 2014 = 3.13; IR 2015 = 4.47) (Fig. 1).

Figure 1.

Quintile distribution of subdistricts of the city of Seville by incidence of tuberculosis in children aged less than 15 years from 2013 to 2015.

We generated this chart using the software application gvSIG, and data on the geographical distribution of the population aged <15 years of year 2013 for calculating the incidence of tuberculosis in this 3-year period.

(0.18MB).

Our findings join the already considerable body of evidence on the association between poverty and tuberculosis (including in the paediatric population) and reveal the considerable health inequalities that exist in relation to TB based on the SES of the area of residence of the inhabitants of Seville. To meet the WHO objectives toward tuberculosis elimination, we must prioritise efforts on the part of welfare and health care organizations for the active search of cases in the most disadvantaged areas of our cities and to raise the awareness of both the public and policy-makers on the need to implement a multidisciplinary strategy to address social determinants of health and the inequalities that they generate.

Acknowledgments

We thank Dr Eduardo Briones Pérez de la Blanca and the Public Health Unit-Department of Epidemiology of the Primary Care Health District of Seville (Department of Health of Andalusia) for their collaboration in accessing the data on the notified cases of TB in the city of Seville.

References
[1]
World Health Organization. Towards tuberculosis elimination: an action framework for low-incidence countries [Internet]. Geneva. 2014 [Accessed 28 Feb 2019]. Available from: https://www.who.int/tb/publications/elimination_framework/en/.
[2]
World Health Organization. Global tuberculosis report 2018 [Internet]. Geneva. 2018 [Accessed 28 Feb 2019]. Available from: https://www.who.int/tb/publications/global_report/en/.
[3]
M. Ordobás Gavín, S. Fernández Rodríguez, S. Cañellas Llabrés, F. Rodríguez Artalejo.
Prevalencia de infección tuberculosa y su relación con la clase social en niños de la Comunidad de Madrid.
[4]
Centro Nacional de Epidemiología-Instituto de Salud Carlos III. Informe epidemiológico sobre la situación de la tuberculosis en España, Año 2016 [Internet]. Madrid; 2016 [Accessed 28 Feb 2019]. Available from: http://www.isciii.es/ISCIII/es/contenidos/fd-servicios-cientifico-tecnicos/fd-vigilancias-alertas/fd-enfermedades/pdf_2019/RENAVE_TBC_2016.pdf.
[6]
Consejería de Sanidad de la Junta de Andalucía.
Zonas de necesidad de transformación social de Sevilla [Internet].

Please cite this article as: Tornero Patricio S, Daponte Codina A, Charris-Castro L. Distribución de las tasas de incidencia de tuberculosis en menores de 15 años según zonas de pobreza de la ciudad de Sevilla. An Pediatr (Barc). 2020;92:231–234.

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